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Neurology System > Epilepsy > Flashcards

Epilepsy Flashcards

1
Q

What is the most common reason for blackout?

A

Vasovagal Syncope

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2
Q

What can cause a blackout?

A 
Syncope 
First seizure 
Hypoxic seizure 
Concussive seizure 
Cardiac arrhythmia 
Non-epileptic attack 
Narcolepsy 
Migraine
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3
Q

What questions are important to ask someone who has blacked out?

A 
What exactly were you doing at the time?
What warning feelings did you get?
What were you doing the night before?
Had you been drinking?
Have you ever had something similar?
How did you feel afterwards?
Any signs on injury, tongue biting or incontinence?
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4
Q

Why should a third party history be done for a blackout?

A

To gather information on observations of the attack

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5
Q

What should be asked to a witness history of a blackout?

A 
Observations before and during the attack 
colour of the patient
Noises 
Foaming of the mouth 
Behaviour following the attack 
Any movements during the attach 
Focus on:
Before 
During 
After
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6
Q

Which sex is more likely to have a non epileptic attack?

A

F

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7
Q

What past medical history information could be relevant to a blackout episode?

A

Head injury
Birth trauma
Febrile convulsions

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8
Q

What is a febrile convulsion?

A

Fit or seizure brought on by fever

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9
Q

What happens in vasovagal syncope?

A

There is a sudden drop in HR and BP

Causing lack of perfusion to brain and fainting

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10
Q

What is syncope?

A

Fainting

With a temporary loss of consciousness

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11
Q

What prodrome symptoms are there for syncope?

A 
Light headed 
Nausea 
Hot 
Sweating 
Tinnitus 
Tunnel
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12
Q

What can trigger vasovagal syncope?

A 
Prolonged standing 
Standing up quickly 
Trauma 
Watching/experiencing medical procedures
Micturition 
Coughing
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13
Q

What are the differences between syncope and seizure with posture?

A

Syncope - upright posture

Seizure - any posture

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14
Q

What are the differences between syncope and seizure with pallor?

A

Syn - common

Sei - uncommon

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15
Q

What are the differences between syncope and seizure with onset?

A

Syn - gradual

Sei - sudden

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16
Q

What are the differences between syncope and seizure with injury?

A

Syn - rare

Seiz - common

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17
Q

What are the differences between syncope and seizure with incontinence?

A

Syn- rare

Seiz - common

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18
Q

What are the differences between syncope and seizures with recovery?

A

Syn - rapid

Sei - slow

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19
Q

What is the difference between syncope and seizures regarding a trigger?

A

Syn - usually an obvious tigger

Sei - usually trigger is rare

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20
Q

When does a hypoxic seizure occur?

A

When an individual is kept upright during a Faint

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21
Q

What causes a concussive seizure?

A

Any blow to the head

Can give a seizure like reaction

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22
Q

Which cardiac arrhythmia can cause syncope?

A

Long QT syndromes
Bradycardia
Tachycardia
AF in older people

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23
Q

When should cardiac syncope be considered?

A

When there is a FH of sudden death

When a young person collapses suddenly with exercise

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24
Q

How are affected more with NES?

A

Women

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25
Q

What can be some features of a NES?

A

Bizarre movements

Not jerky movements

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26
Q

What investigations should be done for a first possible seizure?

A

BG
ECG
CT head

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27
Q

What should be considered with a first possible seizure?

A

Alcohol and drugs

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28
Q

What are the driving regulations for after a first seizure?

A

After a first seizure, a patient may drive a car after 6 months
- if investigations are normal and no further events

They may drive an HGV or PSV after 5 years
- if investigations are normal, no further events and no anti-epileptic medication

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29
Q

When is epilepsy usually diagnosed?

A

After 2nd unprovoked attack

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30
Q

What is epilepsy?

A

Intermittent stereotyped disturbance of consciousness, behaviour, emotion, motor function or sensation which, on clinical grounds, is believed to result from abnormal neuronal discharges

Condition where seizure usually recur spontaneously

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31
Q

What are the classifications of generalised seizures?

A

Tonic-clonic
Myoclonic
Atonic
Absence seizures

32
Q

What is a generalised seizure?

A

When the whole brain is affected

33
Q

What is a tonic clonic seizure?

A

Usually affects the whole brain

Has a stiffening and rhythmical jerking pattern

34
Q

What are the 2 main classes of seizures?

A

Generalised

Focal

35
Q

What seizures are classified as generalised?

A 
Tonic clonic
Myoclonic 
Clonic
Tonic 
Atonic 
Absence
36
Q

Which seizures are classified as focal?

A

Focal seizures with retained awareness

Focal seizures with loss of awareness

37
Q

When is a tonic clonic seizure a medical emergency?

A

> 5 minutes

Recurring seizures one after the other

38
Q

What is an atonic seizure?

A

Type of generalised seizure
There is a sudden loss in muscle tone
Usually causing fall
No convulsion or LOC

39
Q

What is an absence seizure?

A

Brief seizures that begin and end abruptly
When you stare into space for a few seconds
Usually occurs exclusively in children

40
Q

Is there convulsion in atonic seizures?

A

No

41
Q

How long does a tonic clonic seizure usually last?

A

1-3 minutes

42
Q

What is the most common form of seizure?

A

Tonic clonic seizure

43
Q

What happens during a focal seizure with loss of awareness?

A

Seizure limited to one part of the brain - with no loss of consciousness

44
Q

What happens during a focal seizure with loss of awareness awareness?

A

Seizures limited to one part of the brain - with any disturbance of your conscious level

45
Q

Is there any warning in generalised seizure?

A

No

46
Q

With focal seizures is there any warning?

A

May get an aura

May get a warning

47
Q

When do generalised seizures usually present?

A

<25

48
Q

What can focal seizures either simple partial or complex partialdevelop into?

A

Secondary generalised

49
Q

When do focal seizures present?

A

At any age

Can get a brain abnormality at any age

50
Q

What is the most useful thing in seizure investigation?

A

History

Witness history

51
Q

What investigation should be carried out for primary seizures?

A

EEG

52
Q

How can a seizure be evoked?

A

Sleep deprivation

53
Q

When should an MRI be given for seizures?

A

When patient is <50 years

54
Q

What can be used to exclude serious causes of seizures >50 years?

A

CT

55
Q

What is first line daily treatment for generalised epilepsies?

A

Sodium Valproate

Lamotrigine

56
Q

What is first line daily treatment for partial and secondary generalised seizures?

A

Lamotrigine

Carbamazepine

57
Q

What is the first line daily treatment for absence seizures?

A

Ethosuximide

58
Q

What is second line treatment for generalised epilepsy?

A

Levetiracetam

Topiramate

59
Q

What are the side effects of sodium valproate?

A

Teratogenic
Nausea
Pancreatitis
Transient hair loss

60
Q

What are the side effects of Carbamazepine?

A

ataxia, drowsiness, nystagmus, blurred vision

61
Q

What are the side effects of lamotrigine?

A

Skin rash

difficulty sleeping

62
Q

What are the side effects of levetiracetam?

A

Irritability

Depression

63
Q

What is the driving advice for epilepsy?

A

Patients can hold a Group 1 licence once they have been seizure free for a year or have only had seizures arising from sleep for a year.
Day time seizure with a nocturnal pattern must have been developed for 3 years

hold a HGV or PSV licence if they have been seizure free for 10 years
not on anti-epileptic medication

64
Q

What is status epilepticus?

A

Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures

65
Q

What is the effect on the brain of status epilepticus?

A

Very metabolically demanding on the body

Eventually brain cells will be damaged

66
Q

What is the first line treatment for status epilepticus?

A

Lorazepam
Midazolam
Diazepam

67
Q

When should midazolam be repeated?

A

after 10 mins

68
Q

When should lorazepam be repeated?

A

After 10 mins

Once

69
Q

What is the 3rd line treatment for status epilepticus?

A

Anaesthesia

70
Q

What is the 2nd line treatment for status epilepticus?

A

IV Phenytoin

IV Valproate

71
Q

What is SUDEP?

A

Sudden unexpected death in epilepsy

72
Q

If midazolam, lorazepam and diazepam have been given to a patient in status epilepticus with no effect what should you do next?

A

Repeat the medications used

73
Q

What are types of focal seizures?

A

Simpe partial seizure/retained consciousness

Complex partial seizure/unretained consciousness

74
Q

Who should you avoid giving levetiracetam to?

A

Avoid in those with underlying mental health issues

75
Q

1st line Rx for focal seizures:

A

Carbamezepine or lamotrigine

76
Q

2nd line Rx for focal seizures:

A

Sodium valproate or topiramate

77
Q

3rd line Rx for status epilepticus

A

ICU support

Anaethesia

Neurology System (35 decks)

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